Comparative efficacy of acupuncture therapies in premature ovarian failure: A systematic review and network meta-analysis

IF 3.5 3区医学 Q1 INTEGRATIVE & COMPLEMENTARY MEDICINE Complementary therapies in medicine Pub Date : 2025-02-07 DOI:10.1016/j.ctim.2025.103141

Yonghang Yi, Fengjun Ma, Yang Jiao, Rongqi Zhang, Yunhao Yi, Yuxia Ma

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Abstract

Objectives

Premature ovarian failure (POF) is becoming more common and has a major negative impact on women's mental and physical well-being. The use of acupuncture therapies to treat POF has gained popularity. However, the optimal treatment remains uncertain. This study aimed to systematically review the literature and conduct a network meta-analysis (NMA) to compare the efficacy of different acupuncture and related therapies and identify methodologic weaknesses in previous studies.

Design

We systematically searched six databases from their inception to April 2024 for randomized controlled trials (RCTs) of acupuncture therapies for POF. We assessed methodological quality and risk of bias using the RoB 2.0 tool. The NMA was conducted using R and STATA software based on frequency theory, focusing on overall effectiveness rates and hormone levels. Additionally, we critically reviewed methodological limitations and potential biases in the studies included.

Results

Thirty-seven eligible studies involving 2419 patients were included in this NMA. The NMA results indicated that moxibustion_catgut implantation at acupoint (MB_CIA) (P-score = 0.88; pooled mean difference (95 % CI): 22.07 (1.61–302.48)) showed the highest improvement in overall effectiveness, while warming acupuncture (WA) (0.95; −27.56 (-45.35 to −9.78)) improved follicle-stimulating hormone (FSH) levels best. WA_MB (0.85; −9.35 (-15.08 to −3.62)) and WA (P-score = 0.77) were most effective for luteinizing hormone (LH) and estradiol (E2) levels, respectively. Confidence in evidence ranged from moderate to very low, with low overall confidence. Key methodologic weaknesses included insufficient allocation concealment, lack of blinding, and small sample sizes.

Conclusions

Acupuncture therapies may effectively improve POF. MB_CIA, WA, and WA_MB seem to be the most effective. However, severe methodological constraints, such as insufficient randomization and a lack of blinding, may reduce trust in these results. To offer robust evidence, high-quality RCTs must overcome these limitations.

Systematic review registration

[PROSPERO], identifier [CRD42024550180].

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针灸治疗卵巢早衰的比较疗效：系统综述和网络荟萃分析。

目的：卵巢早衰（POF）正变得越来越普遍，并对女性的身心健康产生重大的负面影响。使用针灸疗法治疗POF已经得到普及。然而，最佳治疗方法仍不确定。本研究旨在系统回顾文献，并进行网络荟萃分析（NMA），比较不同针灸及相关疗法的疗效，并找出以往研究方法上的不足。设计：我们系统地检索了6个数据库，从建立到2024年4月，检索了针灸治疗POF的随机对照试验（rct）。我们使用RoB 2.0工具评估方法学质量和偏倚风险。NMA采用基于频率理论的R和STATA软件进行，重点关注总体有效率和激素水平。此外，我们批判性地回顾了纳入研究的方法学局限性和潜在偏差。结果：本次NMA纳入了37项符合条件的研究，涉及2419例患者。NMA结果显示：艾灸穴位埋线（MB_CIA） (P-score = 0.88；合并平均差值（95% CI）： 22.07(1.61 ~ 302.48))显示整体疗效改善最大，温针（WA） (0.95；-27.56(-45.35 ~ -9.78))对促卵泡激素（FSH）水平的改善效果最好。WA_MB (0.85;-9.35(-15.08 ~ -3.62))和WA （P-score = 0.77）对黄体生成素（LH）和雌二醇（E2）水平最有效。证据的置信度从中等到极低，总体置信度较低。主要的方法缺陷包括分配隐蔽不足、缺乏盲法和样本量小。结论：针刺治疗可有效改善POF。MB_CIA、WA和WA_MB似乎是最有效的。然而，严重的方法限制，如随机化不足和缺乏盲法，可能会降低对这些结果的信任。为了提供有力的证据，高质量的随机对照试验必须克服这些限制。系统评价注册：[PROSPERO]，标识符[CRD42024550180]。

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来源期刊

Complementary therapies in medicine 医学-全科医学与补充医学

CiteScore

8.60

自引率

2.80%

发文量

101

审稿时长

112 days

期刊介绍： Complementary Therapies in Medicine is an international, peer-reviewed journal that has considerable appeal to anyone who seeks objective and critical information on complementary therapies or who wishes to deepen their understanding of these approaches. It will be of particular interest to healthcare practitioners including family practitioners, complementary therapists, nurses, and physiotherapists; to academics including social scientists and CAM researchers; to healthcare managers; and to patients. Complementary Therapies in Medicine aims to publish valid, relevant and rigorous research and serious discussion articles with the main purpose of improving healthcare.